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10 Cards in this Set
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5yr old white female complains of fever, marked weakness, pallor, bone pain and bleeding from nose; HPI: increasing fatigability and recurrent infections in last few months; PE: epistaxis, ecchymotic patches on skin, sternal tenderness, slight hepatosplenomegaly with nontender lymphadenopathy; LABS: normocytic normochromic aanemia, absolute lymphocytosis with excess blasts (30+%), neutropenia, thrombocytopenia, CD10 positive, TdT positive, EBV negative.
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Acute Lymphocytic Leukemia (ALL)
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25yr old white woman presents with high-grade fever, menorrhagia, and weakness; HPI: recurrent infections in recent weeks; PE: pallor, multiple purpuric patches over skin; hepatospenomegaly, gingival hyperplasia, sternal tenderness; LABS: normocytic, normochromic anemia, thrombocytopenia, leukocytosis of myeloblasts and promyelocytes, neutropenia, prolonged PT and PTT; GROSS: bone erosion due to marrow expansion, chloroma formation, splenomegaly; MICRO: myelophthisic bone marrow, Auer rods in myelocytes, peroxidase positive stains on bone marrow and gingivial biopsy
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Acute Myelogenous Leukemia (AML)
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12yr old male presents with high fever, marked pallor and epistaxis, history of recurrent URIs and high grade fever treated with parenteral antibiotics; HPI: marked weakness over past 3 months, lives near industrial unit that handles benzene; PE: pallor of skin and conjunctiva, oral and nasal mucosal petechiae, purpuric patches visible on skin, no significant lymphadenopathy, no hepatosplenomegaly; LABS: anemia, neutropenia, and thrombocytopenia (pancytopenia), anemia with low retic count, normal RBC morphology, negative Coombs' test; GROSS: increased yellow marrow, decreased red marrow; MICRO: hypocellular bone marrow with empty spaces populated by fat cells, fibrous stroma and scattered lymphocytes.
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Aplastic Anemia
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66yr old white male recently diagnosed with chronic lymphocytic leukemia comes into ER complaining of fatigue and tachycardia; HPI: urine has been progressively turning dark and red over the course of the day; PE: dyspnea, pallor of skin and mucous membranes, slight jaundice, splenomegaly; LABS: severe anemia, positive Coombs' test, reticulocytosis, spherocytosis, "bite cells", hemoglobinuria, increased serum indirect bilirubin; GROSS: congestive splenomegaly due to extravascular hemolysis.
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Autoimmune Hemolytic Anemia
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35yr old woman admitted to hospital with left-sided weakness upon awakening; HPI: her first 3 pregnancies were spontaneously aborted and the 4th resulted in unexpected fetal death; PE: mild pallor, left hemiplegia w/ exaggerated deep tendon reflexes, positive Babinski's sign, reddish-blue mottling of skin in fishnet pattern; LABS: mild thrombocytopenia, prolonged PTT, false positive VDRL, presence of anticardiolipin antibody (ACA); IMAGING: hypodensity in right internal capsule.
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Antiphospholipid Antibody Syndrome
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9yr old girl of African descent presents with swelling of left side of face and jaw of 3wks duration; HPI: loosening of upper second left molar 2 wks ago, no pain despite size of tumor; PE: pallor, large, firm, ill-defined mass encompassing entire upper mandible with mild ipsilateral exophthalmos with deformation on left side of face; LABS: normocytic, normochromic anemia, mild leukopenia, positive direct Coombs' test, chromosomal translocation t(8;14) involving c-myc gene; IMAGING: no mediastinal widening; MICRO: cells of uniform size with non-granular basophilic nuclei and some vacuoles, 2-5 nucleoli, high mitotic index and "starry sky" image pattern.
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Burkitt's Lymphoma
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65yr old male lost 12 lbs over the past 4 months with episodes of epistaxis and extreme fatigue; PE: generalized nontender lymphadenopathy, pallor, enlargement of spleen and liver; LABS: markedly elevated WBC (124,000), 90% lymphocytes, no lymphoblasts, mild thrombocytopenia, Coombs-positive hemolytic anemia, smudge cells; GROSS: lymph node enlargement, hepatosplenomegaly with tumor nodule formation; MICRO: bone marrow biopsy shows extensive infiltration, mainly by normal-looking lymphocytes, few lymphoblasts with small dark, round nuclei and scant cytoplasm, B lymphocytes don't mature properly.
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Chronic Lymphocytic Leukemia (CLL)
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40yr old white male has occasional fatigue and increasing abdominal girth (large spleen); PE: pallor of skin and mucous membranes, pain on palpation over sternum; LABS: markedly elevated WBC count (130,000), immature granulocytes with normal-appearing ones, basophilia, eosinophilia, early thrombocytosis, late thrombocytopenia, low leukocyte alkaline phosphatase, chromosomal translocation t(9;22) bcr-abl gene (Ph).
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55yr old male presents with swelling, pain, redness of right leg; HPI: he's retired and leads sedentary lifestyle, admits to 70-pack-year smoking history and occasional alcohol intake; PE: fever, tachycardia (106), mild HTN (142/92), normal RR, lower extremity swollen, pain from calf palpation and dorsiflexion of right foot (Homan's sign); LABS: blood D-dimer elevated; IMAGING: thrombi occluding right common femoral and popliteal veins
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Deep Vein Thrombosis
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25yr old white female continues to bleed steadily after a normal, spontaneous vaginal delivery; HPI: after manual exploration of uterus and subsequent procedure, patient begins to bleed profusely from her gums and continues bleeding vaginally; PE: diffuse bleeding in gums and oral mucosa, bleeding diathesis of skin (petichiae and purpura) with oozing from venipuncture sites; LABS: low fibrinogen, low platelets, prolonged PT and activated PTT, elevated fibrin split products, especially D-dimers; MICRO: microthrombi in arterioles and capillaries, leading to microinfarcts in practically any organ, also hemorrhages and petechiae in involved organs
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Disseminated Intravascular Coagulation
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